Do We Need a National Patient Identifier?

The topic of patient identity and patient matching has been around as long as healthcare. And for good reason. Without it, interoperability is inoperable.

But, for nearly two decades, Congress has refused to fund a patient identifier system. In general, lawmakers have explained their inaction as a reflection of their concern about patient privacy. The recent Equifax breach of personal data security certainly demonstrates the validity of the concern.

And yet, the continued absence of a national patient identifier has cost the average healthcare facility more than $17 million annually in denied claims and potential lost revenue, according to more than two dozen healthcare organizations. In a petition to the Department of Health & Human Services, the providers, payers and health information technology companies declared, “Clarifying Congress’ commitment to ensuring patients are consistently matched to their healthcare data is a key barrier that needs to be addressed.” The signers added, “The absence of a consistent approach to accurately identifying patients has resulted in significant costs to hospitals, health systems, physician practices, and long-term post-acute care (LTPAC) facilities as well as hindered efforts to facilitate health information exchange.”

Other influential groups have also urged funding for a unique patient identifier. These include AHIMA’s MyHealthID advocacy campaign, crowd-sourced initiatives such as CHIME’s funding of a patient identification concept contest and the white paper “A Framework for Cross-Organizational Patient Identity Matching,” from the Sequoia Project. Most recently, Experian Health declared its wealth of credit bureau data makes it the perfect private-sector innovator for patient IDs. According to Dan Johnson, Executive Vice President of strategy, the company doesn’t charge healthcare systems for its Universal Identity Manager, which relies on a combination of probabilistic and referential matching, rather than deterministic matching. “We need to give this away,” Johnson said. “We realized that we almost have to seed the market with this and remove the financial barrier to adoption.”

That said, the timing couldn’t be any worse. With Equifax’s recent breach, the personal information, including driver license numbers and social security numbers of 143 million Americans, were compromised. Experian itself suffered a massive breach in 2015. Should the private sector – specifically credit bureaus –be entrusted with critical personal information that leaves consumers – and in this case, patients – at risk? Doesn’t this seem like a problem better solved by the public sector?

Whether it is best solved by the private or public sector, the monetary incentives are huge. According to an AHIMA survey, more than half of health IT management professionals regularly work on resolving patient matching and duplicate patient record issues. According to an ONC report, each case of misidentification at the Mayo Clinic costs at least $1,200. Intermountain Healthcare spends between $4 million and $5 million per year on technologies and processes intended to ensure correct patient identification.

More than the monetary impact, it’s a safety issue.

8%-12% of hospitals’ medical records are duplicates

On average, 64,000 – 96,000 medical records in an EMR (system) refer to a patient with another existing medical record

The average cost associated with repeated medical care – $1,009

Kaiser Permanente of Southern California has more than 10,000 records for people named Maria Gonzales

Between 8%-14% of medical records include erroneous information tied to an incorrect patient identity

But Congress continues to ban federal funding to develop an NPI and tech vendors are reluctant to share their proprietary information for fear of losing market share. How can we begin to solve for patient data interoperability and health data exchange if we can’t efficiently and effectively identify which patient the data belongs to?

Is the government best-suited for providing a solution to this issue or are we to expect the private sector to solve it?

The private sector seems to have dropped the ball. In fact, it has been carrying the ball for years but continues to apply decades old algorithms that have proven ineffective in matching and linking health records to the right patients.

It is past time for a solution. It’s encouraging that in this harshly partisan environment, five senators (three Democrats: Tammy Baldwin, Elizabeth Warren, and Sheldon Whitehouse and two Republicans: Bill Cassidy and Orrin Hatch) have co-signed a letter requesting the GAO to study the extent of the patient matching problem and make recommendations to the ONC on how to fix it.

It’s a start.

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